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| <table class="wikitable">
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| <tr class="v-firstrow"><th>Probability of infective endocaritis</th><th> Characteristics </th></tr>
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| <tr><td>'''Definite diagnosis by pathological criteria'''</td><td>❑ Microorganisms demonstrated by culture or histological examination<br> of a vegetation, OR <br>
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| ❑ Pathological lesions; vegetation or intracardiac abscess confirmed by histological<br> examination showing active endocarditis </td></tr>
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| <tr><td>'''Definite diagnosis by clinical criteria'''</td><td>❑ 2 major criteria; OR <br>
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| ❑ 1 major criterion and 3 minor criteria; OR <br>
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| ❑ 5 minor criteria </td></tr>
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| <tr><td>'''Possible diagnosis'''</td><td>❑ 1 major criterion and 1 minor criterion; OR <br>❑ 3 minor criteria</td></tr>
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| <tr><td>'''Rejected diagnosis'''</td><td>❑ Firm alternative diagnosis explaining evidence of IE, OR <br>
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| ❑ Resolution of IE syndrome with antibiotic therapy for 4 days, OR <br>
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| ❑ No pathological evidence of IE at surgery or autopsy, with antibiotic therapy for 4 days, OR <br>
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| ❑ Does not meet criteria for possible IE as above</td></tr>
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| </table>
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| {|class="wikitable"
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| ! Criteria!! Definite Infective Endocarditis According to Modified Duke Criteria
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| |-
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| | '''Pathological Criteria'''||
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| :Microorganisms demonstrated by culture or histological examination of a vegetation
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| :Pathological lesions; vegetation or intracardiac abscess confirmed by histological examination showing active endocarditis
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| |-
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| | '''Clinical Criteria''' ||
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| :2 major criteria; or
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| :1 major criterion and 3 minor criteria; or
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| :5 minor criteria
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| |-
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| | '''Possible IE''' ||
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| :1 major criterion and 1 minor criterion; or
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| :3 minor criteria
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| |-
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| | '''Rejected''' ||
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| :Firm alternative diagnosis explaining evidence of IE; or
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| :Resolution of IE syndrome with antibiotic therapy for 4 days; or
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| :No pathological evidence of IE at surgery or autopsy, with antibiotic therapy for 4 days; or
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| :Does not meet criteria for possible IE as above
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| |-
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| |}
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| {{Family tree/start}} | | {{Family tree/start}} |
| {{familytree | | | | | | | A01 | | |A01=<div style="float: left; text-align: left; width: 18em; padding:1em;">'''Identify cardinal findings that increase the pretest probability of wide complex tachycardia''' <br>❑ [[Palpitations]] <br>❑ [[Heart rate]] > 100 beats/min <br>❑ [[QRS complex]] > 120 ms </div> <br> }} | | {{familytree | | | | | | | A01 | | | | | A01= '''Does the patient have allergy to penicillin?'''}} |
| {{familytree | | | | | | | |!| | | }}
| | {{familytree | | | |,|-|-|-|^|-|-|-|.| | }} |
| {{familytree | | | | | | | B01 | | |B01=<div style="float: left; text-align: left; width: 18em; padding:1em;">'''Does the patient have any of the following findings that require urgent cardioversion?''' <br>
| | {{familytree | | | B01 | | | | | | B02 | B01= '''NO''' |B02= '''Yes'''}} |
| ❑ Hemodynamic instability
| | {{familytree | | | |!| | | | | | | |!| | }} |
| :❑ [[Hypotension]]
| | {{familytree | | | C01 | | | | | | C02 | C01= '''Does the patient tolerate oral intake?'''| C02= '''Does the patient tolerate oral intake?'''}} |
| :❑ [[Cold extremities]]
| | {{familytree | |,|-|^|-|.| | | |,|-|^|-|.| |}} |
| :❑ [[Cyanosis|Peripheral cyanosis]]
| | {{familytree | D01 | | D02 | | D03 | | D04 | D01= '''YES'''| D02= '''NO''' | D03= '''Yes'''| D04= '''NO'''}} |
| :❑ [[Mottling]]
| | {{familytree | |!| | | |!| | | |!| | | |!| | }} |
| :❑ [[Altered mental status]]
| | {{familytree | E01 | | E02 | | E03 | | E04 | E01= | E02= | E03= | E04= }} |
| ❑ [[Chest discomfort]] suggestive of [[ischemia]] <br>
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| ❑ [[Heart failure|Decompensated heart failure]]</div>}}
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| {{familytree | | | |,|-|-|-|^|-|-|-|.| | | | | | | | | | | }} | |
| {{familytree | | | B01 | | | | | | B02 | | | | | | | | | | |B01=<div style="float: left; text-align: left; background: #F60A0A; width: 15em; padding:1em;"> {{fontcolor|#F8F8FF| ❑ '''Yes'''}} </div>|B02=❑ '''No'''}} | |
| {{familytree | | | |!| | | | | | | |!| | | | | | | | |}} | |
| {{familytree | | | C01 | | | | | | C02 | | | | C01=<div style="float: left; text-align: left; background: #F60A0A; width: 15em; padding:1em;"> {{fontcolor|#F8F8FF| ❑ Urgent [[synchronized cardioversion|<span style="color:white;">synchronized cardioversion</span>]]<br> | |
| :❑ Provide an initial shock of 100 Joules
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| :❑ If there is no response to the first shock, increase the dose in a stepwise fashion (eg, 100 J, 200 J, 300 J, 360 J)<ref name="ACLS">{{Cite web | last = | first = | title = Part 8: Adult Advanced Cardiovascular Life Support | url = http://circ.ahajournals.org/content/122/18_suppl_3/S729.full | publisher = | date = | accessdate = 3 April 2014 }}</ref><ref name="circ.ahajournals.org">{{Cite web | last = | first = | title = ACC/AHA/ESC Guidelines for the Management of Patients With Supraventricular Arrhythmias—Executive Summary | url = http://circ.ahajournals.org/content/108/15/1871 | publisher = | date = | accessdate = 15 August 2013 }}</ref>
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| ❑ If a patient has polymorphic VT and is unstable, treat the rhythm as VF and deliver high-energy unsynchronized shocks
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| :❑ Provide an initial shock of 200 Joules
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| :❑ Increase the dose if no response to the first shock (eg, 300 J, 360 J, 360 J)<ref name="ACLS">{{Cite web | last = | first = | title = Part 8: Adult Advanced Cardiovascular Life Support | url = http://circ.ahajournals.org/content/122/18_suppl_3/S729.full | publisher = | date = | accessdate = 3 April 2014 }}</ref><ref name="circ.ahajournals.org">{{Cite web | last = | first = | title = ACC/AHA/ESC Guidelines for the Management of Patients With Supraventricular Arrhythmias—Executive Summary | url = http://circ.ahajournals.org/content/108/15/1871 | publisher = | date = | accessdate = 15 August 2013 }}</ref>
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| ❑ Give IV sedation if the patient is conscious
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| ❑ Consider expert consultation }}<ref name="ACLS">{{Cite web | last = | first = | title = Part 8: Adult Advanced Cardiovascular Life Support | url = http://circ.ahajournals.org/content/122/18_suppl_3/S729.full | publisher = | date = | accessdate = 3 April 2014 }}</ref><ref name="circ.ahajournals.org">{{Cite web | last = | first = | title = ACC/AHA/ESC Guidelines for the Management of Patients With Supraventricular Arrhythmias—Executive Summary | url = http://circ.ahajournals.org/content/108/15/1871 | publisher = | date = | accessdate = 15 August 2013 }}</ref> </div> |C02=<div style="float: left; text-align: left; width: 15em; padding:1em;"> ❑ '''[[Narrow complex tachycardia resident survival guide#Complete Diagnostic Approach|Continue with the complete diagnostic approach below]]''' </div>}}
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| {{familytree | | | |!| | | | | }} | |
| {{familytree | | | D01 | | | | D01= <div style="float: left; text-align: left; width: 15em; padding:1em;">❑ '''[[Narrow complex tachycardia resident survival guide#Complete Diagnostic Approach|After the stabilization of the patient, continue with the complete diagnostic approach below]]''' </div>}} | |
| {{Family tree/end}} | | {{Family tree/end}} |
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| ==References==
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| {{Reflist|2}}
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| [[Category:Disease]]
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| [[Category:Emergency medicine]]
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| [[Category:Cardiology]]
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| [[Category:Medicine]]
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| [[Category:Primary care]]
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| [[Category:Resident survival guide]]
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| {{WH}}
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| {{WS}}
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